Suicides Worry Experts at Big Jail in Capital

By ERIN BANCO

August 19, 2013

WASHINGTON — Mike Johnson, 53, hanged himself in his cell at the Central Detention Facility here two weeks ago and died shortly after at the Prince George’s Hospital Center. On June 29, Walter Calloway, 42, hanged himself in his cell. Just two weeks before that, another inmate, Paul Mannina, 58, cut his throat and bled to death.

And last November, Michael English, 30, hanged himself.

The four suicides in less than a year are a record for the 1,800-inmate detention facility, which has experienced eight suicides over all in the past decade.

The increase, which mirrors a rise in suicides over the last 10 years in jails across the country, has mental health experts concerned about what they say is a lack of supervision. The deaths have also raised questions about the mental health provider at the jail, which is on the edge of Capitol Hill and only a few miles from the White House.

The mental health provider, Unity Health Care Inc., employs about 180 staff members at both the Central Detention Facility and the Central Treatment Facility — a set of buildings adjacent to the jail that house “medium security” inmates, including juveniles. Only 14 of the 180 employees are licensed mental health professionals, including board-certified psychiatrists and mental health clinicians, in part the result of staff cutbacks in recent years.

But Michelle Madison, the chief executive of the Unity Health Care Foundation, said in an e-mail that health care resources at the jail were “more than adequate” compared with similar facilities around the country. “We are proud of our work that is contributing to better health outcomes for our patients and the District community as a whole,” she wrote.

Ms. Madison, however, said that Unity was participating with the D.C. Department of Corrections in an internal review of policies and procedures on suicide prevention at the jail.

Current policy calls for Unity to screen all inmates for potential mental health problems before entering the facility. Nurses at the jail are required to physically observe all inmates on the facility’s suicide watch and suicide precaution lists at staggered intervals of at least every 15 minutes. Nurses are also responsible for documenting the inmates’ activities as they occur.

Before Mr. Calloway and Mr. Mannina died at the jail in June, security checks on inmates not on the suicide lists were conducted every 30 minutes. Now they are now conducted on all inmates, regardless of their mental health status, every 15 minutes, jail officials said. After Mr. Johnson’s death this month, the jail again changed policy and said inmates would have to share cells at all times.

Jail officials would not release information about the men who committed suicide or if they were on either the suicide watch or suicide precaution list.

Four inmates have committed suicide at the District of Columbia’s jail since November, mirroring a nationwide increase.

Christopher Gregory / The New York Times

According to a report issued last week by the federal Bureau of Justice Statistics, 310 inmates in jails across the United States committed suicide in 2011 — the highest number since 2002. From 2000 to 2011, suicide accounted for an annual average of 41 deaths per 100,000 inmates and about half occurred within the first week of admission.

Denise Juliano-Bult, a researcher at the National Institute of Mental Health, said there were known times when inmates were at higher risk of attempting suicide, including being taken into custody, going before a judge, moving from one facility to another, or after receiving bad news during a family visit.

“The mental health system is kind of broken, and the criminal justice system is an example,” Ms. Juliano-Bult said. “But we need to look at people through all the systems they come in contact with. We need to look at it in a more holistic way.”

Ms. Juliano-Bult said that in the past, mental health experts had pointed to reductions in state financing to explain increasing suicide rates in local jails and state prisons. Since fiscal year 2009, states across the country have cut more than $1.6 billion from their mental health services budgets, according to the National Alliance on Mental Illness, a mental health advocacy group.

“Over the last five years we have seen tremendous reductions in state allocations for mental health services, and this is exacerbating an already bad situation,” said Chuck Ingoglia, senior vice president at the National Council for Behavioral Health.

Unity Health Care would not discuss its finances, but Ms. Madison, the foundation’s chief executive, said that she had been forced to cut back staff in recent years because the population at the District jail’s two facilities had declined since 2010. Ms. Madison would not say how many staff members worked at the jail at the time.

In addition, mental health experts said that many if not most of the District’s mental health providers were losing money because the District had cut two critical reimbursement rates for Medicaid several years ago. “Mental health providers are today in a fragile state,” said Shannon Hall, executive director of the D.C. Behavioral Health Association. “All of my members are operating at a loss.”

Mr. Ingoglia said he had helped a group of senators led by Senator Debbie Stabenow, Democrat of Michigan, draft legislation, the Excellence in Mental Health Act, that seeks to ensure that behavioral health services receive greater reimbursements under Medicaid. It would provide $1.4 billion in Medicaid financing over a decade for community behavioral health centers nationwide.

Tammy Seltzer, director of the D.C. Jail and Prison Advocacy Project, said about half of those with a serious, persistent mental illness were never connected to mental health services when they were incarcerated.

“They don’t really have a chance,” she said, “if they are not able to connect to those critical services.”